Provider Demographics
NPI:1154455277
Name:ZONGKER, JOHN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:ZONGKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9770 OLD BAYMEADOWS RD
Mailing Address - Street 2:STE. 113
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7909
Mailing Address - Country:US
Mailing Address - Phone:904-636-8999
Mailing Address - Fax:904-998-7804
Practice Address - Street 1:9770 OLD BAYMEADOWS RD
Practice Address - Street 2:STE. 113
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7909
Practice Address - Country:US
Practice Address - Phone:904-636-8999
Practice Address - Fax:904-998-7804
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00122311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics